By Theresa Ahearn
Dental literature has been carefully following the impact of COVID-19 or SARS-CoV-2 infections on oral health. Since early in the pandemic, the American Dental Association (ADA) has been monitoring taste, tongue, and other oral issues reported by COVID-19 patients.
Researchers around the globe have continued to examine the connection between COVID-19 and oral health reporting evidence that COVID-19 may worsen pre-existing dental conditions. An increasing number of studies on oral manifestations of COVID‐19 patients suggest that symptoms ranging from swollen tongues to oral lesions may be possible clinical characteristics of COVID‐19 that could lead to life-saving early detection.
Dysgeusia and Oral Lesions
Research published in Dermatologic Therapy reviewed dysgeusia, the first oral symptom of the novel coronavirus. Changes in the perception of taste in infected patients have been reported worldwide and can be considered an oral manifestation of SARS-CoV2. Along with the causes of dysgeusia, researchers also looked closely at oral lesions and manifestations of COVID-19 patients, including ulcers, depapillated tongue, swelling, erythema, and spontaneous bleeding. Oral lesions in COVID-19 patients were significant in 68% of the cases. Older patients with severe illness with COVID-19 had wide-spread oral lesions, however, the correlation between COVID-19 and oral health is still unclear. Predisposing factors such as bad oral hygiene, stress, immunosuppression, and an inflammatory response secondary to COVID-19 may influence the onset of oral lesions in COVID-19 patients (Iranmanesh, Khalili, Amiri, Zartab & Aflatoonian, 2020). The immune system may also be responsible for the development of oral lesions. The nature of the virus triggers an immune response, that in some patients may lead to opportunistic infections, or exacerbate pre-existing autoimmune conditions.
Gum Disease and COVID-19
According to another study, when it comes to gum disease COVID-19 patients are three times more likely to experience complications. A nationwide case-control study was conducted by researchers in Qatar who examined electronic health records of 568 patients with severe COVID-19 complications. The researchers reviewed both medical and dental data as well as considered factors that might be associated with COVID-19 including body mass index (BMI), history of smoking, heart disease, or high blood pressure. Of the 568 patients, 45% had a history of gum disease. The researchers then adjusted their data for age, gender, smoking, and other conditions. Once other factors were adjusted, the odds ratios for COVID-19 complications in patients with gum disease, compared to those without, were 3.67 for COVID-19 complications, 3.54 for ICU admission, 4.57 for ventilator requirement, and 8.81 for death ( Marouf et al., 2021 ). The patients with periodontitis were at least three times more likely to experience COVID‐19 complications, including ICU admission and ventilation. Additionally, COVID-19 patients with periodontitis showed increased levels of biomarkers associated with worsened disease outcomes including white blood cell levels, and c-reactive protein. Additionally, oral bacteria in patients with periodontitis can be inhaled and worsen lung infections, especially for patients who are on a ventilator, raising the risk of death ( Marouf et al., 2021 ).
Though there is not enough evidence alone to suggest that COVID-19 causes gum disease, worsening of pre-existing conditions including inflammation of the gums can result in long-term effects, including loss of teeth. This new research suggests that even a causal link between gum disease and COVID-19 is a cause for concern.
Doctors, dentists, and patients continue to report perplexing oral side effects of COVID-19. Among the dental community, another side-effect often reported is “COVID Tongue.” The CDC does not include swollen or discolored tongues as a symptom of COVID-19 though several accounts of patients with COVID who experience a swollen tongue have been emerging in the media. In January 2021, an NBC news story broke that quoted a British researcher, Tim Spector, a professor of genetic epidemiology who warned that an enlarged or discolored tongue may present in COVID-19 patients. Spector reported he had received dozens of statements of tongue problems via the app ZOE, which is used by COVID-19 patients to describe their symptoms ( A. Pawlowski, 2021 ). Coincidently, a report published in the British Journal of Dermatology, in 2020 studied over 600 COVID-19 patients and found that 7% presented with tongue inflammation with patchy depapillation that was not caused by other circumstances or treatment ( Nuno-Gonzalez et. al., 2020 ).
A growing body of scientific evidence suggests a correlation between COVID-19 infections and oral health conditions. There is much value in additional research on how the novel coronavirus can impact not just the body but overall dental health. Also, an oral manifestation of COVID-19 can be an important contribution in the search for resolutions regarding early diagnosis and treatment.
Author: Theresa Ahearn is a freelance writer, currently residing in Oak Ridge, Tennessee. She received her Bachelor of Arts from the New York Institute of Technology and Master of Science from Central Connecticut State University. When not writing she can be found fishing or traveling someplace new.